Your question: Desferal injection technique

Your Question:
What is, in your opinion, the best way to inject Desferal?

My Answer:
I have had the experience of helping patients with Beta Thalassaemia major use Desferal injections by different injection techniques.

• Intravenous injections:
  I am personally very uncomfortable with patients using Desferal intravenously (direct injection into the blood via a vein) as an infusion. The risk of sudden high doses entering the blood stream and causing major problems is my worst fear with this technique. Theoretically, using IV Desferal in a hospital setting is relatively safer that at home. This is because in a hospital it should be easier to deal with potential problems than at home. I personally think that IV Desferal use is too intrusive, invasive, relatively unsafe and potentially troublesome. It is also a lot more challenging for patients to acquire the skills necessary to self administer Desferal IV. I personally don't recommend this method.
• Intravenous via a porta cath:
  I have seen some patients who have had subcutaneously (just under the skin) implanted catheter devices on their body into which they self inject (as a slow infusion) their Desferal doses. I consider this to be virtually the same as intravenous injection. It is definitely a lot easier in this case to gain IV access for injection, but it is associated with potential complications with the catheter itself. I personally don't recommend this technique either. Immediate side effects are common with both these techniques and are not very well tolerated by most patients who have tried it.
• Subcutaneous via pump:
  This is till date, the most widely used, most widely accepted and most widely studied injection technique. The Desferal dose is prepared in a syringe which is then "loaded" into the pump. The mechanical pump then slowly (over 8-12 hours) injects the medication via a needle inserted just beneath the skin. This is probably the safest way to inject Desferal. Most patients prefer to "wear" the pump at night allowing it to inject the medication when they sleep. The biggest hurdles in this technique are the incidences of local injection site side effects (swelling, pain, redness, itching…etc) and the need for about 10 hours on average for the injection. Some people more than others have serious injection site problems that hinder regular use of Desferal. Even considering all this, pump is perhaps the safest, easiest, most effective and most widely accepted injection technique for Desferal. I would recommend this technique more than any other (exceptions: read below).
• Subcutaneous as short infusions:
  Again the medication is prepared in a syringe. It is attached to a tubing at the end of which is a needle. The needle is inserted into the space just below the skin and medication injected slowly over 20-30 minutes.Although originally developed as a 10 minute "bolus" injection, I support the slower injection over 20-30 minutes and prefer to call it "short infusion". The total daily dose is divided into a morning and an evening dose. This is increasingly becoming popular with patients who weren't finding "the 10 or so hours" needed for the pump. They have one injection before going to work and one before going to bed. It is effective, generally safe (but less so than the pump) and less time consuming. The local injection site problems are similar to the pump technique. I would recommend this technique for anyone who is unable to use pump.
• Intra muscular injection:
  Painful and unsafe. I have met people who were on this injection technique in the late 70s (the then commonly used technique). I don't recommend this technique. I believe this technique to be only of historical significance.

Now that I have written all that, I would like to say that it really is not my choice what technique a patient uses. I would certainly recommend one or more techniques depending on circumstances, but it is ultimately the choice of the patient which technique he or she wishes to use. There are advantages and disadvantages to each of these techniques and individualised plans have to be the right way to go.

I would like to encourage everyone to discuss with their doctors before making changes to their medications. There are ways in which we can help minimise and control side effects or the severity of it. In case of a medication like Desferal, which I consider to be an essential life-saving medication for patients with Beta Thalassaemia major, it is important to do everything possible to help patients optimise their regular use.

It is not easy for the patients to adhere to this difficult treatment. But when it is an essential treatment, we must find ways and means to persevere.

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